Bjorn Kragsterman, MD, PhD, of Uppsala University Hospital in Sweden, and colleagues explain that previous studies have suggested an absolute risk reduction of approximately 5% for stroke or death at 5 years after asymptomatic stenosis CEA, but long-term follow-up after asymptomatic stenosis CEA is not well documented. Therefore, they analyzed population-based long-term survival after asymptomatic stenosis CEA and assessed the possible impact of different risk factors. The authors reported that perioperative stroke or mortality was lower in patients with asymptomatic stenosis (2.2%) than in patients with symptomatic stenosis (4.4%). However, at 10 years after surgery, the absolute survival risk was 8.3% lower in the asymptomatic group than in the symptomatic group. 5-year survival was significantly lower in the asymptomatic stenosis group (78.2%) than in the symptomatic stenosis group (81.1%). Although there was no significant difference in late survival between the asymptomatic and symptomatic cohorts, this in itself was an unexpected finding, the investigators said. Factors associated with lower 5-year survival included previous vascular surgery, heart disease, diabetes and increased age, the report noted. Perioperative stroke did not significantly reduce 5-year survival. The authors concluded that long-term survival after asymptomatic stenosis carotid endarterectomy is an important consideration when deciding on this prophylactic measure. In this population-based study, a significant reduction in long-term survival was observed. However, these patients represent a selected group, and no overall conclusions can be made for all patients with asymptomatic stenosis based on these results.